Wisconsin Administrative Code
Department of Employee Trust Funds
Chapter ETF 11 - Appeals
Section ETF 11.02 - Definitions
Current through August 26, 2024
Words, phrases and terms used in this chapter have the same meanings as set forth in s. 40.02, Stats., and s. ETF 10.01, except as defined in this chapter or where the context clearly indicates a different meaning. In this chapter:
(2) "Administrative agent" means a person who has entered a contract with a board or the department to provide administrative services to a program administered by that board or the department under ch. 40, Stats. The term includes the administrative agent of the group insurance board or department who assists in the administration of a group insurance plan under ch. 40, Stats., for which the public employee trust fund is the insurer.
(3) "Appeal" means the review of a written finding, notification or decision specifically set forth in a determination made by the department conducted by a board under s. 40.03(1) (j), (6) (i), (7) (f), or (8) (f), Stats.
(3m) "Appeals coordinator" means the department staff responsible for receiving appeals, forwarding appeals to the hearing examiner, and working directly with the hearing examiner and board on administrative matters regarding an appeal.
(4) "Appellant" means the person, including a participant, annuitant, beneficiary, employer, insured, insurer or deferrer who initiates an appeal to the board. "Appellant" also includes a person appealing an adverse determination of participating employee status.
(5) "Board" means the employee trust funds board, deferred compensation board, group insurance board, teachers retirement board or Wisconsin retirement board according to the context of its application.
(6) "Board staff" means the department employees assigned by the secretary to perform tasks in support of the board.
(7) "Deferrer" means an employee who participates in the deferred compensation program under ch. 40, Stats.
(8) "Determination made by the department" means a written finding, notification or decision of the department, which includes a notice of appeal rights and applies law or contract terms to actual facts to determine a benefit, right, obligation or interest under ch. 40, Stats., including contracts authorized by ch. 40, Stats., of a person who is, or claims the status of, a participant, annuitant, beneficiary, employer, insured, insurer or deferrer.
(9) "E-mail" means to send via electronic mail over a computer network.
(10) "Hearing examiner" means the person who presides over each appeal of a determination made by the department of employee trust funds including an administrative law judge employed by the division of hearings and appeals.
(11) "Insured" means a person covered under a group insurance plan provided under ch. 40, Stats.
(12) "Insurer" means the person bearing the financial risk and liability for payment of claims under a group insurance plan provided under ch. 40, Stats., including where applicable the public employee trust fund.
(13) "Mail" means to send via the U.S. mails as at least first class mail, and includes sending by express mail, special or overnight delivery, certified or registered mail.
(14) "Respondent" with respect to an appeal means the department of employee trust funds. In addition:
(15) "Substantial interest" means, with respect to an appeal under this chapter, a direct and material interest in the particular determination made by the department, which interest is specially and adversely affected, either by the particular determination itself or by the result sought by the appellant of that determination, beyond the effect common to other similarly situated persons. The term does not include a derivative, indirect or mere nominal interest.
